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GI Conditions Flashcards

1
Q

How is constipation classified in children? (symptoms)

A

2 or fewer defecations a week

history of excessive stool retention, painful/hard bowel movement, large diameter stool, retentive posture

one episode/week of incontinence after acquisition of toileting skills

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2
Q

What is the step-wise treatment of functional constipation in children?

A

1) regular doses of stool softener or osmotic laxative

2) if 1 not work, use stimulant laxative

3) ineffective monotherapy, combination of laxatives

4) glyceryl suppositories

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3
Q

Name the stool softeners used to treat constipation (children)

A

Poloxamer = <6months, 6-18months, 18-36 months

Docusate = 3-6, 6-12 years old

liquid paraffin = 1-6 yrs, 7-12 yrs, <12 yrs

It is a first line treatment

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4
Q

Name the osmotic laxatives used to treat constipation (children)

A

lactulose = <1 yrs, 1-5 yrs, 6-12 yrs, >12 yrs

Macrogol +/- electrolyte = 1-12 yrs

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5
Q

Name the stimulant laxatives used to treat constipation (children)

A

Senna = 2-6 yrs, 7-12 yrs

Bisacodyl = >3 yrs, 6-months -2yrs

Sodium picosulfate drops = 4->10 years

All stimulant laxatives are given at night

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6
Q

What are some key points to consider when treating constipation in children?

A

regular doses of laxatives

gradual reduction of laxative meds = prevent further impaction

med treatment can be continued for several months

avoid prune juice/brown sugar water

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7
Q

Referral points for constipation in children

A

Faecal impaction

ineffective general treatment

chronic (>6 months duration)

pain

affecting child’s lifestyle

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8
Q

What is diarrhoea?

A

defined as at least three loose or liquid bowel movements, accompanied by increased freq and fluidity relative to normal stool

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9
Q

What is the main focus for diarrhoea treatment?

A

prevent dehydration and correct fluid loss & electrolyte loss

treat cause if possible

relieve symptoms

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10
Q

Referral points for diarrhoea

A

diarrhoea alternating constipation, intermittent

blood or mucus/both in stool, chronic med conditions, suspected laxative misuse, fam history of GI disease

symptoms >14 days, severe symptoms (8-10 motions/day)

severe abdominal pain, unintentional weight loss

pregnancy, infant <6 months, <1 year (Symptoms last >24 hrs)

recent overseas travel

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11
Q

What is the first line treatment for diarrhoea?

A

oral rehydration therapy, avoid sugar hydration products

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12
Q

What is second line treatment for diarrhoea?

A

Antimotility agents:

symptomatic relieve adults/children >12 yrs old

for mild/moderate acute diarrhoea

short term control for social inconvenience

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13
Q

What are some contraindications for antimotility/ anti-diarrhoeal agents?

A

Severe diarrhoea

possibility of invasive organism

severe irritable bowel syndrome

Acute management of infants and young children

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14
Q

What are the available anti-motility agents?

A

loperamide (+/- simethicone)

diphenoxylate (+atropine)

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15
Q

What schedules do loperamide belong to?

A

unscheduled= 8 pack or less

S2 = 20 pack or less

GastroStop has PBS listing = authority requirements

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16
Q

What schedules do diphenoxylate belong to?

A

S2 = 8 pack or less
S4 = 20 pack or more

PBS listing available

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17
Q

Briefly mention Giardiasis

A

parasitic infection of small intestine found in water contaminated by raw sewage or animal waste

Transmitted also person-person (poor hygiene)

Symptoms (come and go)= diarrhoea, stomach cramps, gas, nausea

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18
Q

What commonly treats giardiasis?

A

metronidazole, three times a day for 5 days

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19
Q

Discuss rotavirus

A

cause of acute viral gastroenteritis in children, most common cause of severe diarrhoea in children

resolves = 3-9 days

Transmission = rota virus shed in stool, spread via contaminated hands/objects

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20
Q

How is rota virus diarrhoea treated?

A

treated depending on severity of dehydration

Oral rehydration supplements

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21
Q

How is rota virus diarrhoea prevented?

A

Oral rotavirus vaccine

85-98% effective against severe rota virus after 3 doses (2, 4, and 8 months of age)

won’t prevent diarrhoea and vomiting caused by other organisms

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22
Q

What causes GORD?

A

weakened or impaired function of lower GI sphincter

Inc intra-abdominal pressure –> reduced oesophageal clearance –> impaired mucosal defence

reduction of salivary secretion can inc exposure to gastric acid

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23
Q

When is GORD classified?

A

heartburn/reflux symptoms occur more than 2+ days per week and become troublesome

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24
Q

What are some GORD symptoms/signs?

A

heartburn, excessive burping

regurgitation of food or acid, upper abdominal pain/discomfort

sore throat, waterbrash, difficulty swallowing, persistent dry cough, angina-like chest pain

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25
What factors exacerbate GORD?
Diet, supine position post eating medications inc gastric pressure Tobacco smoking, bending or straining, wearing tight clothing, stress
26
What medications worsen GORD?
Anticholinergics, sedating antihistamines antidepressants, nitrates, CCB, nicotine, benzodiazepines, beta blockers, NSAIDs
27
When to refer a patient with GORD
Anaemia, weight loss, anorexia, dark stools, swallowing impairment (dysphagia, odynophagia) nocturnal choking, persistent cough, vomiting red blood radiating chest pain
28
What drugs are used to treat GORD?
Antacids = 1st line in preg, quick onset Simethicone = used alone or with antacids Alginates = used alone or with antacids H2 antagonists = used in preg PPIs = most potent
29
What H2 antagonists are used to treat GORD?
Famotidine Nizatidine Ranitidine (least drug interactions) Begins to work in 1 hours, persist 6 - 12 hrs
30
Name the PPIs used in GORD
omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole Pack of 7 = S2 Pack of 14 = S3
31
What is the PSA protocol for supply PPIs?
Asses = presenting signs and symptoms, symptoms freq, age (>18, <55), prior treatments, lifestyle, medical/fam history, current meds Confirm recommendation appropriate = treatment option, C/I, preg/lactating, drug interaction
32
What are some PSA PPI counselling points?
take 30-60 mins before meal acid liable, has enteric coating = do not crush or chew slow onset of action, use antacids initially well tolerated, can cause = headache, nausea, diarrhoea, constipation, flatulence discuss lifestyle mods, alarm symptoms to look out for, referral advice
33
Outline the step down approach to PPIs in GORD
H2 antagonist is initial therapy = greater efficacy at standard dose PPIs at standard dose (therapeutic trial 4-8 wks) = rapid symptoms relief and heal erosive diseases present Review maintenance therapy regularly
34
Things to consider in well controlled GORD
Stopping treatment unless patient has severe oesophagitis or complicated disease Intermittent use when symptoms are present Step down to low dose therapy
35
What are some acute and chronic causes of vomiting/nausea?
Medicines (NSAIDs, opiods, chemo drugs) GI disorders (GORD, IBS, GI obstruction) Vertigo, motion sickness Pregnancy
36
What is motion sickness?
Response to abnormal signals, brain difficulty processing conflicting signals Common in children 2-12 years old
37
How do you prevent motion sickness?
Dry crackers, ventilation, look forward, look at horizon, dont read or focus on games in move vehicle
38
Name the pharmacological treatments for motion sickness
Promethazine Dimenhydrinate + hyoscine, caffeine Hyoscine hydrobromide
39
When should promethazine be taken?
Long trip = start the night before Short trip = 1-2 hrs prior to travel
40
When should dimenhydrinate (travelcalm) be taken?
Commence 20-30 mins before trip
41
When should hyoscine hydrobromide be taken?
20-30 mins prior to travel
42
What are some non-pharm motion sickness treatments?
Acupressure = sea band, travel calm band. Target P6, pericardium acupuncture pressure point. Two to three fingers width down from wrist Ginger =Take 3 days prior to travel, safe in pregnancy, 30 mins before travel and repeated every 4 hrs
43
What are some haemorrhoids symptoms?
Pain, irritation, swelling, burning, mucous discharge, bleeding (bright only, not mixed with stool)
44
What are some causes of haemorrhoids?
constipation = meds, lack of fibre, dehydration Pregnancy = resolves after birth straining = bowel motions, cough/sneeze, heavy lifting obesity long periods of sitting
45
What are non-pharm treatments of haemorrhoids?
Drink water, dont strain, high fibre diet, look at meds being taken, exercise if possible, eight loss
46
What general treatments are available for haemorrhoids?
Astringents Local anaesthetics corticosteroids
47
What astringents are available for haemorrhoids? What do?
Zinc = forms protective coating, soothing relief
48
What local anaesthetics are used to treat haemorrhoids?
Lignocaine, benzocaine, cinchocaine = freq application, pain relief
49
What corticosteroids are used for haemorrhoids?
hydrocortisone (cream), prednisolone (oral, S4) = reduce inflammation and itching Caution = can only be used for 7 days max.
50
What combination products are available for haemorrhoids?
Proctosedyl ointment and suppositories (S2) = cinchocaine + hydrocortisone Scheriproct (S4) = cinchocaine + prednisolone
51
What are referral points for haemorrhoids?
Pregnancy, known GI conditions associated with bleeding (Crohns, ulcerative colitis) Not seen GP before, blood in stool, unexplained rectal bleeding, marked protrusion, fever, abdominal pain Recent unusual change in bowel habit
52
What is an anal fissure?
slit-like tear or defect in anal canal lining, usually acute and will heal in 4-8 weeks (becomes chronic afterwards) Localised trauma --> spasm of anal sphincter + inc resting anal sphincter pressure ---> reduced blood flow & poor healing
53
What are the symptoms of anal fissure?
Pain (intense and last minutes/hrs after defecation) bleeding (bright red) mucous discharge itching
54
What are the treatments for anal fissures?
Break cycle of anal sphincter spasm, inc fibre intake and/or laxatives warm bath topical ointments
55
What topical ointments and creams can treat anal fissures?
glyceryl trinitrate (topical) = 3-4x a day, 4-8 wks, limited healing effect lignocaine = pain relief hydrocortisone = anti-inflam CCB (topical: diltiazem, nifedipine) = vasodilation
56
What are some considerations for glyceryl trinitrate use?
C/I = sildenafil, tadalafil, vardenafil (PDE-5 inhibitors) ADRs = headache, light headed stop use = severe headache, dizziness Advice = avoid straining, inc fibre/fluid intake or use bulking agents
57
How are hookworms and rounworms treated?
Albendazole (S4) Mebendazole, pyrantel (OTC)
58
What is the first line treatment for threadworms/pinworms?
mebendazole, pyrantel, albendazole
59
What are the treatments for tapeworms?
1) Praziquantel 2) niclosamide
60
What are the treatments for whipworm?
1) albendazole 2) mebendazole
61
What are the treatments for strongyloidiasis?
1) ivermectin 2) albendazole
62
True or false albendazole is safe in pregnancy?
False
63
Is pyrantel safe in pregnancy?
Can be used, dosage determined by weight repeat after 2 weeks
64
Is mebendazole safe in pregnancy?
Yes but avoid in trimester 1 Repeat after 2-4 weeks if unsuccessful
65
What is the community deworming program?
In communities with high rates of intestinal worm infections treated with albendazole once a year Deworming program improves nutrition and growth target age = 6 months and 12 years

Prof Pharmacy I (11 decks)

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